| NPI | 1891014502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61308522) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA18157) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2023-09-26 |